tbuckley/cabot-search huggingface dataset:
Poster No. 109 Prognostic value of white blood cell count variation during in-hospital stay in STEMI patients: Insights from SCALIM Registry
Authors: Marouane Boukhris, Camille Dierx Molié, Pierre Chenard, Amandine Gourceyrol, Amandine Gasnier, Patrice Virot, Victor Aboyans
Journal: Cardiovascular Research (2022)

Abstract Background In patients with ST-elevation myocardial infarction (STEMI), white blood cell count (WBCC) is associated with infarct size and cardiovascular outcome. We sought to determine the impact of WBBC variation (?WBCC) during in-hospital stay on long-term outcome after STEMI. Methods From 2011 to 2019, consecutive patients with STEMI were enrolled. Those with at least two WBCC during hospitalization were included in this study. ?WBCC was calculated as: [WBCC (admission) – WBCC (before discharge)]. The population was divided into 3 groups according to ?WBCC tertiles. The primary outcome was total mortality. Results A total of 1778 patients (mean age 64.5 ± 14.1, 75.7% males), were included and divided in 3 groups: Group 1 (?WBCC &amp;lt; 0.85 103/mm3); Group 2 (?WBCC 0.85–3.31 103/mm3); and Group 3 (?WBCC &amp;gt; 3.31 103/mm3). Patients in Group 1 were the oldest (67.9 ± 13.8, vs. 65.1 ± 13.9 and 60.5 ± 13.7 years in Groups 2 and 3 respectively, P &amp;lt; 0.001). Hypertension, prior coronary artery bypass and cancer were more prevalent in Groups 1 and 2. Troponin peak was the highest in Group 3 (3601 ± 563) than Group 2 and 3 (2810 ± 439 and 2451 ± 467 ng/ml, respectively; P &amp;lt; 0.001). Five-year survival was the lowest in Group 1 (78.6% vs. 87.2% and 87.5% in Group 2 and 3, respectively; P &amp;lt; 0.001). Adjusted to age, gender, cardiovascular risk factors, MI territory and left ventricular ejection fraction, ?WBCC &amp;lt; 0.85. 103/mm3 was independently associated with all-cause mortality [HR 1.46; 95%CI 1.12–1.91; P = 0.005]. Conclusion ?WBCC &amp;lt; 850/mm3 Is associated with increased mortality. Low ?WBCC during hospitalization could represent an interesting prognostic tool in STEMI patients.
Poster No. 009 In-hospital bleeding in acute coronary syndrome: new antithrombotics, old problems
Authors: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, José Pedro Sousa, João Lopes, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, Lino Gonçalves
Journal: Cardiovascular Research (2022)

Abstract Background Progress in decreasing ischemic complications in acute coronary syndrome (ACS) has come at the expense of increased risk of bleeding. This study sought to determine the incidence, predictors, and prognosis of in-hospital bleeding (IHB) in ACS patients. Material and methods We retrospectively analyzed patients consecutively admitted to the coronary care unit (CCU) with ACS. Patients who suffered clinically significant IHB were compared to the remaining ACS patients. The primary endpoint was all-cause in-hospital death. Results and conclusions From a total of 1032 ACS patients, clinically significant IHB was identified in 5.6% (n = 58) of patients, of whom 13 patients presented serious bleeding. Patients with IHB were older (P = 0.003), more often female (P = 0.012), were more likely to have prior heart failure (P = 0.007) and chronic kidney disease (P = 0.001). At admission, they presented more often with Killip-Kimball class &amp;gt; I (P = 0.001), lower hemoglobin (P = 0.013), lower eGFR (P = 0.005), and a higher CRUSADE score (P &amp;lt; 0.001). In multivariate logistic regression, female sex (OR = 2.26, 1.17–4–38, P = 0.023), acute kidney injury (OR = 2.23, 1.12–4.45, P = 0.028), and non-radial access in coronary angiography (OR = 2.04, 1.08–3.87, P = 0.028), were identified as independent predictors of IHB. The primary endpoint occurred in 5.8% of ACS patients. Patients who suffered IHB were at higher risk of death during hospitalization (OR = 2.39, 95% CI 1.03–5.51, P = 0.042), but not during the 2-year follow-up (P = 0.429). In conclusion, IHB is not an uncommon complication in ACS patients and is associated with an increased risk of in-hospital mortality.
Clinical Case 06—A fatal dance: a case report of a pulmonary embolism with mobile right ventricular thrombus
Authors: Carolina Miguel Gonçalves, Mariana Carvalho, Adriana Vazão, Sara Fernandes, Margarida Cabral, Rita Carvalho, Hélia Martins, Fátima Saraiva, João Morais
Journal: Cardiovascular Research (2022)

Abstract Presentation We report a case of a 44-year-old woman with past medical history of dyslipidemia under atorvastatin, overweight and depression, that presented to the emergency department with a 1-month history of dyspnea. On physical examination, blood pressure was within normal range, however she was hypoxemic, needing oxygen via nasal cannula, and tachycardic. Pulmonary auscultation revealed basal crackles. Blood workup showed discrete leukocytosis, increased C-reactive protein, mild hypertransaminasemia and increased troponin and NT-proBNP levels. An EKG revealed sinus tachycardia with 123 beats per minute. A D-shaped left ventricle, an enlarged right ventricle and right heart mobile thrombus were observed in a transthoracic echocardiogram. Diagnosis Scoring 2 points on simplified Wells’ Score and with a visible mobile right ventricular thrombus, pulmonary embolism was suspected and further confirmed by computed tomographic pulmonary angiography. Management: In the absence of hemodynamic instability this case fulfils criteria for intermediate-high risk pulmonary embolism. Therefore, anticoagulation with enoxaparin was started under strict electrocardiographic monitoring. Unfortunately, a day later the patient had a sudden cardiac arrest in asystole, with no recuperation after prolonged advanced life support and administration of rescue thrombolysis (alteplase 50mg). Learning points
Poster No. 071 Application of artificial intelligence in coronary CT angiography:a potential gatekeeper strategy?
Authors: José Miguel Viegas, João Ferreira Reis, Rita Teixeira, Sofia Jacinto, Tiago Mendonça, Ruben Ramos, Hugo Marques, Luísa Figueiredo, James Earls, Rui Cruz Ferreira
Journal: Cardiovascular Research (2022)

Abstract Introduction Medical artificial intelligence (AI) is rapidly developing and moving from the research field to daily clinical practice. AI algorithms have demonstrated high performance and computational efficiency, reducing the degree of manual input and processing time. Objectives This study aimed to determine the impact of an AI-enabled coronary computed tomography angiography (CCTA) analysis for comprehensive evaluation in patients (P) with suspected coronary artery disease (CAD). Methods We analysed 100 CCTA exams from a cohort of symptomatic P with mild-to-moderately abnormal non-invasive ischemia test. Stenosis severity was assessed by level III experts (manual evaluation, MEv). A novel AI-based software tool (automatic evaluation, AEv) was also used to quantify coronary stenosis and characterize plaque phenotype. In P later referred for invasive coronary angiography (ICA), diagnostic and revascularization yields of MEv and AEv were compared. Results 100P, 52% male, mean age 68 ± 10 years, one-third had typical angina. Prevalence of obstructive CAD determined by MEv and AEv was 25% and 21%, respectively, with a significant association between both assessments (P &amp;lt; 0.001). Based upon MEv, referring physician decided to proceed to ICA in 22P (21P with significant stenosis). For those undergoing ICA,13P also had obstructive CAD established by AEv. Diagnostic yields for MEv and AEv-guided ICA was 82% and 60%, and revascularization yields 73% and 60%, respectively. AEv atherosclerosis quantification revealed significant differences between P who did not undergo ICA, P referred for ICA without significant stenosis and P with obstructive CAD on ICA: total (126 vs. 312 vs. 518 mm3, P &amp;lt; 0.001), calcified (23 vs. 197 vs. 222 mm3, P &amp;lt; 0.001), non-calcified (71 vs. 112 vs. 252 mm3, P &amp;lt; 0.001) and low-density plaque volume (1.1 vs. 3.0 vs. 4.4 mm3, P = 0.042). Conclusion A diagnostic strategy using AI-based analysis of coronary stenosis severity on CCTA had a similar performance compared to MEv. In addition, risk prediction can be enhanced by AI assessment of plaque composition. This study is an example of the potential role of AI in the CCTA workflow.
Oral Presentation No. 019 Bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways in patients with ST-segment elevation myocardial infarction
Authors: Rahim Kanji, Ying X Gue, Mohammed F Farag, Nicola J Mutch, Diana A Gorog
Journal: Cardiovascular Research (2022)

Abstract Background Impaired endogenous fibrinolysis is a risk factor for recurrent cardiovascular events in patients with acute coronary syndrome (ACS). Ongoing inflammation is also an adverse prognostic risk factor. While inflammatory markers are elevated in patients presenting with ST-segment elevation myocardial infarction (STEMI), whether there is a direct relationship between markers of inflammation at presentation, and the effectiveness of endogenous fibrinolysis in this setting, is unclear. Our study aimed to assess the relationship between markers of inflammation, coagulation and fibrinolysis, in patients with STEMI. Material and methods We conducted a prospective, observational study in consecutive patients presenting with STEMI. Blood was drawn on admission after dual antiplatelet therapy loading, but before administration of anticoagulants. The sample was immediately tested to assess endogenous fibrinolysis using the point-of-care Global Thrombosis Test. In addition, blood samples were tested for leucocyte and neutrophil count, neutrophil-to-leucocyte ratio (NLR), platelet-to-leucocyte ratio (PLR), fibrinogen, standard coagulation markers and high sensitivity C-reactive protein (hs-CRP). Results and conclusions The cohort consisted of 129 patients (aged 66 ± 13 years, 78% male). Whole blood endogenous fibrinolysis time correlated with fibrinogen (r = 0.300, P = 0.001) and hs-CRP (r = 0.236, P = 0.011). Hs-CRP correlated with fibrinogen (r = 0.631, P &amp;lt; 0.001). There was no relationship between whole blood lysis time and leucocyte count, NLR, PLR, international normalised ratio or activated partial thromboplastin time. The effectiveness of endogenous fibrinolysis in whole blood is related to fibrinogen and hs-CRP levels. Our findings strengthen the evidence for bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways, providing mechanistic insights that could help guide pharmacological strategies to treat hypofibrinolysis.
Poster No. 043 A Case of Post Thrombotic Syndrome and AV Fistula arising from Recurrent DVT Secondary to May – Thurner Syndrome (MTS) in an Elderly Woman
Authors: Angeline U Y Lim, Marilou de Jesus, Fabio Enrique Posas, Marvin Martinez
Journal: Cardiovascular Research (2022)

Abstract May-Thurner Syndrome (MTS) remains to be an overlooked condition wherein the right common iliac artery compresses the left common iliac vein. Rarely reported, MTS has other different variants with the iliac vein being compressed by an ipsilateral artery. Iliofemoral DVT poses a significant impact because of venous claudication and DVT recurrence. MTS usually occurs in women, ages 20–40 y/o, and is thus rarely included in differential diagnosis of DVT in elderly patients presenting with persistent unilateral leg swelling. Treatment of DVT alone with anticoagulation is insufficient to address thrombotic MTS. Failure to address the mechanical compression leads to poor quality of life due to high predisposition to recurrent DVT, and at times to other complications such as post-thrombotic syndrome and formation of AV fistulas. We present a case of an 89 year old woman, hypertensive, non-smoker, no history of cancer, presenting with progressive left lower extremity swelling with erythema, violaceous discoloration, varicosities, telangiectatic skin lesions, hyperpigmentation and calf tenderness. Ultrasound revealed DVT at common iliac vein extending to the popliteal veins. CT studies showed a left common iliac artery compressing the left common iliac vein with early enhancement of the common femoral vein, indicating presence of fistula. Peripheral angiography and venography findings were consistent with CT scan findings, with incidental findings of multiple small AV fistulas. Anti-coagulation was given and IVC filter was inserted. An attempt to do catheter-directed thrombolysis was unsuccessful. Subsequently, she underwent Palma's surgery which provided significant improvement and was sent home ambulatory.
Oral Presentation No. 10 Pharmacological therapy in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): long-term prognosis
Authors: Vanessa Lopes, Nádia Moreira, Rafaela Fernandes, Gil Cunha, Gonçalo Costa, Eric Monteiro, Diogo Fernandes, Joana Guimarães, James Milner, Vera Marinho, Sílvia Monteiro, Pedro Monteiro, Francisco Gonçalves, Lino Gonçalves
Journal: Cardiovascular Research (2022)

Abstract Background The optimal management of myocardial infarction with nonobstructive coronary arteries (MINOCA) is still uncertain. This study sought to determine the association between pharmacological therapies after hospital discharge and the long-term prognosis of MINOCA patients. Material and methods We analyzed patients consecutively admitted to the coronary care unit with myocardial infarction (MI). Multivariate analysis was performed to determine which drugs were implicated in the prognosis of MINOCA patients. The primary endpoint was all-cause mortality at 5 years. Results and conclusions From a total of 3721 MI patients, MINOCA was identified in 11.6% (n = 430), of whom 56 (13.0%) experienced the primary endpoint. Median age was 66 years (IQR 19), and 51.6% (n = 222) of patients were male. At discharge, 81.2% of MINOCA patients were prescribed aspirin, 87.4% a statin, 78.6% beta-blockers, and 66.7% angiotensin-converting enzyme inhibitors (ACEI). MINOCA patients were less likely to be prescribed these medications compared to patients with obstructive coronary artery disease (all P &amp;lt; 0.001). 1.4% (n = 6) of MINOCA patients died in the hospital, and the 5-year mortality rate was 13.0% (n = 56). In multivariate Cox regression, treatment with ACEI at discharge was found to be independently associated with a 5-year mortality benefit (HR = 0.29, 95% CI 0.12–0.67, adjusted P = 0.004) in MINOCA patients. In conclusion, compared with patients with obstructive CAD, patients with MINOCA are less likely to be treated with secondary prevention drugs and are at lower risk of all-cause mortality during long-term follow-up. Treatment with ACEI seems to provide an additional mortality benefit in MINOCA patients.
Poster No. 040 Traversing boundaries inside the heart
Authors: Inês Pereira Oliveira, Isabel Cruz, Rafaela Lopes, Bruno Bragança, Inês Campos, João Azevedo, Aurora Andrade
Journal: Cardiovascular Research (2022)

Abstract An 84-year-old man with previous pulmonary embolism (PE) was admitted to hospital for acute dyspnea. He was normotensive, but tachypneic and tachycardic. Non-relevant findings on auscultation. ECG showed sinus tachycardia and blood tests depicted elevated D-dimers and troponin I. Angio-CT diagnosed a PE. Echocardiogram (echo) showed an enlarged right ventricle with depressed function, a flattened septum with paradoxical movement, preserved left ventricular function, no intracavitary masses. Enoxaparin was started. Days later he developed new left sided hemiparesis. Acute ischemic cerebral lesion on CT scan. Echo disclosed a new hyperechogenic highly mobile mass attached to the interatrial septum moving from the right to the left atrium, suggestive of thrombus. Anticoagulation was maintained and on new echo evaluation days later there were no intracardiac masses. Agitated saline echo testing disclosed the presence of a patent foramen ovale, supporting the previous notion that a thrombus was moving between interatrial chambers. Oncological screening and prothrombotic evaluation were not completed due to unfavorable clinical evolution. Paradoxical embolism (PaE) is usually a presumptive diagnosis. It is rarely found in clinical practice, though its prevalence may be underestimated due to the transient nature of the phenomenon and the difficulty in identifying a venous thrombus-in-transit through a cardiac defect and subsequent arterial embolism. The presence of a thrombus-in-transit modifies the treatment strategy, requiring urgent management due to the impeding risk of PaE, with treatment options comprising anticoagulation, thrombolysis and thrombectomy. Although no consensus exists regarding optimal strategy, surgical embolectomy is the favored approach in most published cases.
Oral Presentation No. 082 Pre-treatment with Dual Antiplatelet Therapy in NSTE-ACS: not always, not ever
Authors: António Rocha de Almeida
Journal: Cardiovascular Research (2022)

Abstract Background Decision of which antithrombotic therapy strategy for non-persistent ST-segment elevation acute coronary syndromes (NSTE-ACS) remains controversial. European Cardiology Society guidelines ceased recommending pretreatment with P2Y12 receptor inhibitor in NSTE-ACS, based on Accoast Trial, which demonstrated absence of ischemic benefits and higher bleeding risk. However, sample studied didn't illustrate Portuguese reality. Material and methods Cohort of 2194 NSTE-ACS patients from a multicenter national registry, treated according standard of care, between 2010–2019, was compared with Accoast Trial 1996 results of patients no pretreatment sample. Results and conclusions There was no statistically significant difference on age, sex distribution, aspirin or antithrombin therapy. 96.5% of Portuguese sample were pretreated with dual antiplatelet therapy (DAPT). Trial's sample had median time to coronary angiography (CA) of 4.2 hours and femoral access in 57.0% and Portuguese group had a median time of 12 h-36 h till CA, and femoral access in 11.6%. Just 0.7% had urgent surgery in Portuguese sample. There was more cardiovascular caused deaths, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout (9.8%) on trial sample, against only 5.0% on ours. Pretreatment group had slighter increase of TIMI major bleeding (1.8% vs. 1.4%), with median timing 3.5 days after. Earlier CA may explain trial's absence of ischemic benefits. Later bleeding complications might be associated with DAPT strategy itself, and not with timing. Due to lack availability, surgery wasn't done before 5 days. Hence, DAPT pretreatment shouldn't be for all NSTE-ACS, nevertheless, can be valid option, according to bleeding and ischemic risk, CA timing, access, or surgery availability.
Retracted: Clinical Case 25—Intrinsic prothrombotic states and his influence on the management of the patient with acute myocardial infarction
Authors: Miguel Carias de Sousa, Bruno Piçarra, Ângela Bento, Manuel Trinca
Journal: Cardiovascular Research (2022)

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Poster No. 133 Local TGF-beta sequestration by fibrillin-1 regulates vascular wall homeostasis in the thoracic aorta
Authors: Julie de Backer, Violette de Leeuw, Mathias Van Impe, Marine Vanhomwegen, Gerlinde Logghe, Margie Oblinado, Marco Stampanoni, Patrick Segers, Laura Muino Mosquera, Lynn Sakai, Patrick Sips
Journal: Cardiovascular Research (2022)

Abstract Introduction Marfan syndrome (MFS) is caused by a defect in fibrillin-1, which binds TGF-beta via interaction with latent TGF-beta binding proteins (LTBPs). The role of TGF-beta in MFS is controversial. Objectives use dedicated mouse models for MFS, with defects interfering with TGF-beta binding and function, to gain insights into the role of TGF-beta signaling in aneurysm formation and dissection. Material &amp; methods Mice lacking the binding site for LTBPs (Fbn1H1Δ/+ and Fbn1H1Δ/H1Δ), mice with a truncated fibrillin-1 (Fbn1GT-8/+), and mice with a combination (Fbn1GT-8/H1Δ) were subjected to cardiac ultrasound and ex vivo synchrotron X-ray imaging. Results Only Fbn1GT-8/H1Δ mice showed increased mortality (aortic rupture) starting at 4–5 months, whereas all other mice had a normal life span. Aortic root dilatation occurred both in Fbn1GT-8/+ and Fbn1GT-8/H1Δ mice at 6 months, but not in Fbn1H1D/+ or Fbn1H1Δ/H1Δ mice. Significant elastin fragmentation was observed in the thoracic aortic wall of Fbn1GT-8/+ mice, and to a larger extent in Fbn1GT-8/H1Δ mice. Surprisingly, localized elastin fragmentation was also found in the ascending aorta of Fbn1H1Δ/+ and Fbn1H1Δ/H1Δ mice, despite a lack of aortic aneurysm formation. Moreover, Fbn1H1Δ/H1Δ mice displayed more severe aortic wall damage. Conclusion Our data suggest that loss of LTBP binding to fibrillin-1 leads to the development of localized aortic microdissections in the absence of aortic aneurysm, and exacerbates the aortic wall morphology abnormalities in mice with truncated fibrillin-1. We therefore hypothesize that local TGF-beta sequestration is required to maintain aortic homeostasis.
Poster No. 004 Cardiovascular and metabolic effects of ovarian suppression as adjuvant therapy for early breast cancer: a systematic review and meta-analysis
Authors: Ying Gue
Journal: Cardiovascular Research (2022)

Abstract Background Adjuvant endocrine therapy is key treatment in early oestrogen receptor positive breast cancer (BC). In premenopausal BC ovarian function suppression (OFS) in combination with tamoxifen or aromatase inhibitor (AI) is commonly used, particularly in high-risk patients who have received chemotherapy. The profound suppression of circulating oestradiol associated with OFS could have adverse cardiovascular and metabolic effects, We aim to evaluate the reported adverse effects within randomised phase III trials in premenopausal women with BC. Methods A systematic search of online databases was conducted to identify randomised control trials (RCTs) involving OFS which reported adverse events (hypertension, weight gain, thrombosis, cardiac ischemia, glucose intolerance and hyperglyacemia). Pooled odds ratios (OR) with 95% confidence interval (CI) were estimated using a random-effects model. Results Four RCTs were included in the metanalysis with a total of 7808 patients, separated into 3 main treatment groups: Tamoxifen, OFS plus Tamoxifen and OFS plus AI. We found that OFS increased risk of hypertension when compared to Tamoxifen alone (7.6% vs. .4.8%, OR 1.49,95%CI 1.09–2.01; P = 0.01). Tamoxifen with OFS increased risk of thrombosis when compared to AI with OFS (1.7% vs. .0.7%, OR 2.87,95%CI 1.19–6.9; P = 0.02). Conclusions This highlights the possible impact of OFS in premenopausal women as it increases risk of developing hypertension which may require closer monitoring and initiation of early treatment. There appears to be a protective effect of AI when compared to Tamoxifen in terms of thrombosis. Further studies are needed to explore the impact of these drugs on the cardiovascular health of these young women with BC.